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Not surprisingly, incarceration's extreme separation and stress have significant negative effects on romantic relationships. Unfortunately, few programs have been developed to improve jailed individuals' romantic relationship with their non‐incarcerated partner. The present study investigated the effectiveness of the individual version of the digital OurRelationship program for incarcerated individuals. The current study is a program evaluation of services provided by PayTel Inc. (a provider of eLearning and communication devices in US jails) between June 2020 and November 2021. Of the 5411 individuals in a romantic relationship who started the program, 3034 completed it. Following completion of the program, 78% reported feeling “Mostly” or “Very Satisfied” with the program, and 77% reported “Slight” to “Strong” agreement that their relationship benefited from the program. Individuals' relationship confidence (d = 0.36) and relationship knowledge (d = 0.33) significantly improved during the program. Women and Latino/Hispanic and Asian/PI individuals experienced the largest pre‐post gains in relationship functioning. Furthermore, racial/ethnic minority groups tended to report higher satisfaction with the program. Overall, the high rates of program satisfaction and significant pre‐post changes—combined with their reduced barriers to dissemination—support the delivery of digital relationship programs for jailed individuals interested in strengthening their relationship. [ABSTRACT FROM AUTHOR]

Background: Integrating the approach based on acceptance and commitment with the approach of schema therapy to be more effective and respond to a wider range of couple problems has attracted the attention of researchers. Aims: This study aimed to determine the effectiveness of the combined approach of couple therapy based on acceptance and commitment with schema formulation (ACT/SF) on psychological flexibility and marital satisfaction. Methods: The research method used was quasi-experimental with a pre-test, post-test design, and a control group. The statistical population consisted of all couples referred to counseling centers in Qom in 2022. From this population, 16 couples (32 people) were selected using available sampling and divided into two groups: control and experimental. Both groups completed the ENRICH Marital Satisfaction Scale and the Acceptance and Action Questionnaire-II (AAQ-II) in the pre-test and posttest. The experimental group received therapeutic intervention for twelve 120-minute sessions. Data analysis was performed using covariance analysis at a significant level (P<0.05). Results: The results indicated that, by controlling the pre-test as a covariate variable, the experimental group experienced a significant increase in marital satisfaction with a strong effect size (η2= 0.62) and in psychological flexibility with a medium effect size (η²= 0.32). Conclusion: The combined approach of couple therapy based on acceptance and commitment with schema formulation significantly improves psychological flexibility and marital satisfaction. This is achieved through formulating problems, recognizing schemas, and becoming aware of cognitive distortions, which helps people understand and be more aware of their own and their spouse's psychological processes. Techniques based on acceptance and commitment are then used to encourage couples to improve their relationships based on their values. [ABSTRACT FROM AUTHOR]

The cornerstone of the contextual family therapy model is predicated on the belief that all family members benefit from trustworthy relationships, which result from (a) acknowledging the contributions of deserving family members, (b) engaging in responsible interactions, and (c) ensuring a fair distribution of relational burdens and benefits. Nonetheless, conflicts may arise when one partner asserts a claim to relational resources based on need, while the other believes they are entitled to such resources based on merit. Based on relational ethics and the development of trust, this paper focuses on the therapist's role in facilitating the conflict‐resolution process to assist couples in reestablishing individual responsibility and accountability within the systemic framework of couple therapy. It elucidates several clinical strategies, including (a) cultivating trust through fairness and focusing on the importance of reciprocity and equitable give‐and‐take, (b) detecting destructive entitlement, and (c) marital relationships and ethics of care. Several clinical examples are discussed, as well as common couple relational issues associated with horizontal and vertical relationships, partnership, and fusion, and the impact of gender and power dynamics and trustworthiness based on the feminist lens. [ABSTRACT FROM AUTHOR]

Guided by the Person‐of‐the Therapist Training (POTT) Model, the current qualitative study explores emotional experiences and emotion regulation strategies of emotionally focused trained therapists who work with high‐conflict couples in Turkey. Twenty‐one therapists who completed at least the externship in emotionally focused couple therapy (EFCT) and had prior or current clinical experience working with high‐conflict couple(s) were recruited through various social media platforms and professional organizations' listservs. Semistructured individual interviews were conducted, audio‐recorded, and transcribed verbatim. Thematic analysis of the qualitative data revealed five main themes: (1) Different Compelling Emotional Experiences of the Therapists, (2) Sun After Storm, (3) Triggers of Therapists' Emotions, (4) Perceived Adaptive Emotion Regulation Strategies, and (5) Positive Impact of the Therapist's Regulation Strategies on the Therapy Process. Overall, the findings supported the three phases of the POTT model: namely, knowledge of self, access to self, and use of self. Our study demonstrates the need for integrating self‐of‐the‐therapist work into the clinical practice, training, and supervision of therapists working with distressed couples. [ABSTRACT FROM AUTHOR]

Alliance ruptures and their repair are robustly associated with outcomes in individual therapy. Little is known about these processes in couple therapy, despite the acknowledged challenges of nurturing the alliance when working with two parties in conflict. One factor contributing to this gap in the literature is the lack of an instrument to capture ruptures and repair in couple therapy. We adapted the Rupture Resolution Rating System (3RS) to identify ruptures and repairs in couple therapy at the within‐system (between the two partners) and the between‐system (between each partner and the therapist) levels. Sessions from one couple with good outcome and one couple with poor outcome were coded. Couples were in therapy to deal with emotional injury. Rupture‐repair events in both the within‐system and between‐system were common. The couple with the poor outcome showed greater levels of rupture with the therapist. The injured partners (vs. injurer partners) demonstrated higher frequencies of ruptures. [ABSTRACT FROM AUTHOR]

We examined the prevalence of relationship undermining statements by therapists treating couples, as reported by clients, and the association of these statements with outcomes. Participants (n = 270) reported on recollections of their therapist saying that they were incompatible, that therapist could not help them, that the relationship was beyond repair, that divorce was the best or most realistic option, or told one of partners that the other had a personality problem, or proposed individual therapy instead of couple therapy. Findings showed a prevalence rate of 10-28% across these five undermining statements; 40% of clients reported at least one statement. Undermining statements were associated with poorer outcomes and shorter duration of couple therapy. We suggest that some therapists treating couples lack a systemic/relationship framework and set of skills, which leads them to become frustrated and pessimistic with difficult couple cases. We offer implications for the training of couple therapists. [ABSTRACT FROM AUTHOR]

This study examined the development of the therapy alliance over the first six sessions of couple therapy using a dyadic latent growth curve. The role of relationship adjustment, symptom distress, and attachment to alliance development were also examined. Participants were 165 couples in a treatment-as-usual setting. The alliance increased over the first six therapy sessions for males and females with males following a curvilinear pattern of growth. Additionally, female relationship adjustment was related to initial alliance levels for females while symptom distress was related to female alliance development. Male attachment avoidance and female attachment anxiety were related to male initial alliance. Couple therapists need to pay attention to intake level of female adjustment, symptom distress, and attachment—along with male attachment, as these are related to alliance development. Therapists should also be mindful that female and male alliance follow a different developmental trajectory. [ABSTRACT FROM AUTHOR]

AbstractA presentation of infidelity has been described as one of the most challenging issues to work within couple therapy. Yet the subjective experiences of therapists as they engage with couples working through infidelity remains poorly understood. We undertook a grounded theory study building on the Person of The Therapist (POTT) model to explore this phenomenon. Eight therapists with up to 20 years’ professional experience who drew on a range of professional theoretical orientations formed our sample. Our analysis led us to conclude that the concept of ambivalence best captured and described therapists’ experiences of working with infidelity. We identify three distinct facets of this theme and developed a model of its trajectory over the course of the therapeutic process. In this way, our work contributes to our understanding of how therapists deal with infidelity and provides some much-needed guidance for therapists working in this field. [ABSTRACT FROM AUTHOR]

Objective: The increasing prevalence of marital conflicts in contemporary society, the risk of separation, and its negative impact on the mental health of couples and their children is one of the most significant issues, sometimes affecting even three generations of a family. The effectiveness of Gottman's Systemic Cognitive Couple Therapy on marital conflicts, communication patterns, and alexithymia in couples with marital conflict was examined. Methods and Materials: This study utilized an applied and quasi-experimental design with a pre-test, post-test, and follow-up, accompanied by a control group. The statistical population of this study included all couples who referred to counseling clinics in District 1 of Tehran from June to September 2023. Among them, 30 couples were selected through convenience sampling and randomly assigned to experimental and control groups. The interventions included seven sessions of Gottman's Systemic Cognitive Couple Therapy (2008) administered to the experimental group. Data were collected using the Christensen and Sullaway (1984) Communication Patterns Questionnaire, the Bagby, Parker, and Taylor (1994) Alexithymia Scale, and the Barati and Sanai (1996) Marital Conflict Questionnaire. The data were analyzed using repeated measures ANOVA and SPSS-22 software. Findings: The results of data analysis indicated that systemic cognitive couple therapy was effective on marital conflicts (F=40.30, P<0.001), communication patterns (F=13.53, P<0.001), and alexithymia (F=3.59, P=0.036) in couples with marital conflict (P<0.01). Conclusion: It can be concluded that couple therapy can be utilized to improve marital conflicts, communication patterns, and alexithymia in couples experiencing marital conflict. [ABSTRACT FROM AUTHOR]

We sampled routinely collected measures of role and outcome expectations, the expanded therapeutic alliance, and relationship satisfaction completed by 253 heterosexual couples seen by 35 therapists in the Marriage and Family Research Practice Network (Johnson et al., 2017) and investigated these variables as interdependent dyadic processes using the latent congruence model (Cheung, 2009) and the mediated actor–partner interdependence model (Ledermann et al., 2011). Taken together, we found a direct association between a couple's mean role and outcome expectation scores at Session 1 and individual partners' alliance perceptions at Session 3. Further, men rated the alliance more favorably when their outcome expectations were higher and the partners' outcome expectations were less discrepant. In terms of role expectations, both men and women began therapy expecting to be more actively engaged in the process than their partner. Whereas women rated the alliance more favorably when they had high role expectations for their partner as well as themselves, men rated the alliance more favorably when they had high expectations for their female partner's engagement in the therapy. Notably, alliance at Session 3 did not mediate the association between initial expectations and Session 4 relationship satisfaction due to a strong association (r = 0.85) between relationship satisfaction rated prior to Sessions 1 and 4. In other words, although the best predictor of relationship status before the fourth session was how the relationship was perceived before couple therapy began, men's and women's initial role and outcome expectations were important contributors to the early alliance. Public Significance Statement: Heterosexual couples routinely completed measures of role and outcome expectations (before Session 1), the expanded therapeutic alliance (before Session 3), and relationship satisfaction (before Sessions 1 and 4). The alliance was stronger when as a couple, both partners anticipated positive results and expected each other to play an active role in therapy; men rated the alliance more positively when the couple's initial outcome expectations were less discrepant. At the outset of therapy, both partners expected to be more actively engaged in the process than their partner. Nonetheless, the best predictor of Session 4 relationship satisfaction was how positively clients rated their relationship before therapy began. [ABSTRACT FROM AUTHOR]

This pilot study examined the process and outcome of Developmental Couple Therapy for Complex Trauma (DCTCT) with seven couples. DCTCT is a novel form of couple therapy designed to address complex posttraumatic stress disorder symptomatology and couple‐level distress in trauma survivors and their partners. These couples showed statistically significant improvements in overall trauma symptoms, emotion regulation capacities, and reductions in attachment‐related anxiety. These results suggest that DCTCT may be a promising approach to intervention. Future directions include the development of a sequential care model, because resource limitations may not allow for all couples to receive the full treatment model over 40 weeks; it will also be important to address measurement issues in relation to mentalizing, to allow for observational coding across the course of therapy. [ABSTRACT FROM AUTHOR]

AbstractResearch has found mixed results regarding pornography use in the context of mixed-gender romantic relationships. Gottman’s Sound Relationship House measures were given to 402 men married to women to further explore how pornography use relates to relationship functioning. Results showed overall relationship functioning being negatively correlated with pornography use, moderated by the level of religiosity—consistent with previous findings on pornography use and religiosity. Contrary to hypotheses, spousal acceptance of pornography and viewing pornography together did not moderate the negative correlation between relationship functioning and pornography use. Implications for couple and relationship therapy are discussed. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusionThis exploratory study investigated the association between interpersonal movement and physiological synchronies, emotional processing, and the conversational structure of a couple therapy session using a multimodal, mixed-method approach.The video recordings of a couple therapy session, in which the participants’ electrodermal activity was recorded, were analyzed. The session was divided into topical episodes, a qualitative analysis was conducted on each topical episode’s emotional aspects, conversational structure and content. In addition, movement and physiological synchrony were calculated in each topical episode. Regression models were used to discover the associations between qualitative variables and synchronies.Physiological synchrony was associated with the emotional aspects of the session and to episodes in which the spouses’ relationship was addressed, while movement synchrony was only related to emotional valence. No association between synchrony and conversational structure was found.The findings suggest that physiological and movement synchrony play distinct roles in psychotherapy. The exploratory study sheds light on the association between momentary synchrony, emotions, and conversational structure in a couple therapy session. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance. Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators. Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction. Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality. [ABSTRACT FROM AUTHOR]

Background: Infertility is one of the disturbances that may occur in the lives of couples, leading to experiences of psychological distress and endangering interpersonal relationships and marital quality. This study investigated the efficacy of intensive shortterm dynamic psychotherapy (ISTDP) in enhancing distress tolerance and marital quality of life among infertile women in Yazd, Iran.Methods: A semi-experimental pretest-posttest follow-up design with an experimental and control group (n=20 per group) was employed. Forty infertile women from the target population in Yazd, Iran (data collected in 2023) were randomly assigned into either the experimental group receiving eight 45-minute ISTDP sessions or the control group receiving no intervention. For data collection, questionnaires on distress tolerance and perceived relationship quality components were used. Data analysis was done by a repeated-measures analysis of variance (ANOVA) in SPSS version 27 was used.Results: According to the results, for distress tolerance, the mean score for the ISTDP group at the pretest was 31.55 (±13.14), which increased to 50.10 (±9.31) at posttest and 49.70 (±8.68) in the follow-up. The mean score for the control group at the pretest and posttest were 32.05 (±10.28) and 32.25 (±10.17), respectively. Moreover, for the marital quality of life, the mean score for the ISTDP group at the pretest was 70.40 (±19.47), which increased to 90.70 (±20.59) at the posttest and 91.15 (±20.75) at the follow-up. The mean score for the control group at the pretest and posttest was 66.85 (±21.75) and 65.85 (±20.66), respectively. There was a statistically significant within-group effect in the ISTDP group (P

ABSTRACTBackground: Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD.Objective: The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive–Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders – provider’s treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD.Results: There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments.Conclusions: This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships.

The current study draws on interviews with service users about their experiences to inform the practice of psychodynamic couple therapy for depression. Five participants, who had received at least six months of psychodynamic couple therapy in London (UK) for the treatment of severe distress and depression, completed a semi‐structured interview. They were recruited using a purposive sampling technique. Data was analysed using a phenomenological approach to thematic analysis. Six themes were identified in relation to participants' experiences of couple therapy. Key aspects highlighted by participants include: the therapist, described as a 'third person', became a referee and mediated the communication within the couple, providing a different perspective, enabling a safe environment for reciprocal listening; the process of making links with the past enabled participants to understand their current behaviour as individual and dysfunctional areas as a couple; the therapist's ability to understand the couple as individuals rather than as a unified entity was key; therapist neutrality and capacity to empathise with the couple was valued by participants. The study highlighted the intertwined dynamic between relationship difficulties and depression. Participants were not able to make a clear distinction between these two experiences, and this microcosm may reflect the difficulties that clients face in accessing public services, which have historically held a more individualistic perspective of distress. [ABSTRACT FROM AUTHOR]

The transition to parenthood, or the addition of another child to the family system is a life altering event for both mothers and fathers that can affect both parents individually and their relationship. For some parents, this includes perinatal suicidal ideation. Despite the prevalence of perinatal mood disorders, there are no systemic models designed specifically for couples who are at risk for suicide. This paper reviews the literature on the prevalence of perinatal suicidal ideation and proposes an integrative treatment model using aspects of Collaborative Assessment of Suicidality (CAMS), Attachment based family therapy (ABFT), and Emotionally Focused Therapy (EFT). [ABSTRACT FROM AUTHOR]

Cognitive behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is associated with improvements in patients' and partners' mental health and relationship satisfaction. Some pretreatment relationship characteristics have predicted CBCT for PTSD outcomes for patients, but findings were limited to a single community sample consisting primarily of female patients with male partners. A better understanding of whether pretreatment relationship characteristics predict outcomes in other patient populations and whether there are partners who may be particularly responsive to couple therapy for PTSD could optimize treatment matching. This study investigated whether pretreatment partner accommodation and relationship satisfaction predicted patient and partner treatment outcomes from an uncontrolled trial of an abbreviated, intensive, multicouple group version of CBCT for PTSD conducted with 24 active-duty military or veteran couples (96% male patients/female partners). In general, changes in patients' PTSD and comorbid symptoms and relationship satisfaction did not vary by pretreatment partner accommodation or patients' own pretreatment relationship satisfaction. In contrast, pretreatment relationship characteristics predicted partner outcomes. Partners who engaged in higher levels of accommodation pretreatment and partners who reported lower levels of pretreatment relationship satisfaction experienced greater declines in psychological distress following treatment. Also, partners who began the study relationally distressed exhibited significant increases in relationship satisfaction following treatment, whereas those who were not relationally distressed did not. Findings suggest that improvements generally do not vary by pretreatment relationship characteristics for patients, whereas partners who begin treatment with elevated relationship risk factors may be especially likely to experience improvement across outcomes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Data from a two‐arm randomized controlled trial of emotionally focused therapy (EFT) compared to usual care were used to examine whether baseline emotion regulation influences relationship satisfaction for female and male partners. This is clinically relevant as clinicians have debated whether clients' initial emotion regulation skills predict positive outcomes in EFT.Dyadic multilevel modeling was used to determine whether baseline emotion regulation predicted both initial levels and change in relationship satisfaction and whether that relationship differed by treatment group (i.e., EFT or usual care).Baseline emotion regulation difficulties were associated with lower initial relationship satisfaction. However, baseline emotion regulation difficulties were not associated with change in relationship satisfaction over the course of treatment and this relationship did not differ by treatment group.Results demonstrate that partners with diverse presentations of emotion regulation at baseline may benefit from couple therapy. [ABSTRACT FROM AUTHOR]

Couple therapists have the unique and challenging opportunity of helping people find deeper connection in their intimate relationships. These clinicians apply therapeutic models and interventions designed to help couples. However, many of these models are derived from theoretical, scientific, and sociocultural traditions that conceptualize human phenomena as individualistic and reductionistic, and the language in these theories may not match clients' experiences, which include deeply relational phenomena such as love and loss. We review how Western scientific and sociocultural traditions have shaped conceptualization of problems and clinical intervention in couple therapy. In contrast, we provide an alternative, strongly relational framework for couple therapy that draws upon philosophical perspectives asserting that relational, rather than individual, experience is fundamental in human interaction. These ideas provide relational language which can influence how couple therapy is viewed and enacted. Specifically, we discuss how a strongly relational approach changes how therapists understand and intervene with conflict, abuse, love, and deception. This relational framework can help couples in their own goals to become more unified. Implications for the therapeutic relationship, interventions, and scholarship are provided. [ABSTRACT FROM AUTHOR]

Research shows that shame can have a severe negative impact on intimate relationships, leading to negative shame loops between partners. In this article, we aim to provide a theoretical analysis of how attachment theory can help us understand that shame loops within couple relationships may not only be triggered by negative cues, such as criticism from a partner but can also innocently be triggered by a partner seeking connection or even offering comfort. We also elaborate on how therapists may unexpectedly trigger and intensify a client's shame. We conclude by providing a case description and discussing the therapeutic implications that can be helpful when working with the paradoxes of shame in couple therapy. [ABSTRACT FROM AUTHOR]

The purpose of this study is to advance theory concerning the experiences of couples and therapists involved in online couple therapy and the meanings they assign to them, with a particular focus on the therapeutic alliance. Using constructivist grounded theory methodology, in‐depth semi‐structured online interviews were conducted with 36 individuals, including 18 couples who had participated in online couple therapy via videoconference. Additionally, 15 couple and family therapists were interviewed in four online focus groups. Our analysis indicates three dimensions that impact the formation of the therapeutic alliance in online couple therapy: (1) emotional closeness, as a conduit for establishing physical or emotional space; (2) limited care, due to the therapist's difficulty providing comfort and security; and (3) body language, as reflected in the lack of physical presence and the close inspection of the face, at two opposite ends of a continuum. We discuss our findings through the lens of the closeness‐distance dynamic, which posits that therapists' ability to regulate themselves depends on their clients' emotional needs. We conclude with implications for clinical practice. [ABSTRACT FROM AUTHOR]

The clients' experiences of couple therapy, as gathered through open-ended qualitative questions, has historically been underrepresented within the field. However, recent years have found more studies inviting the perspectives of the clients. Such studies provide important contributions to the widening of the understanding of the various aspects of couple therapy. This study set out to synthesize, through the means of qualitative meta-analysis (QMA), findings across primary qualitative research studies on helpful, difficult but helpful and unhelpful aspects of couple therapy. A final sample of 21 qualitative studies was selected through a comprehensive search and rigorous appraisal. The meta-analysis yielded nine main meta-categories across three domains: four in the helpful aspects' domain, for example "Clients' Perception of Therapist as Effective in Establishing a Productive Therapeutic Relationship with Couple"; three in the unhelpful aspects' domain, such as "Therapist Perceived as Lacking Abilities Required to Work with Clients Effectively"; and two in the difficult but helpful domain, such as "Therapist Perceived as Firm but Fair". The present QMA allows a conceptualization of couple therapy through the lenses of clients and its details can thus inform the field of couple therapy. [ABSTRACT FROM AUTHOR]

Abstract Background Research suggests that interpersonal dysfunction may be central to borderline personality disorder (BPD), and that the relationships of people with BPD are particularly impaired. Further, the significant others of people with BPD exhibit elevated psychological problems but little access to mental healthcare. Despite this, most BPD interventions are delivered individually and do not routinely incorporate significant others. This manuscript presents the first case series of Sage, a 12-session manualized intervention for people with borderline personality disorder (BPD) and their intimate partners with three targets: a) BPD severity, b) relationship conflict, and c) intimate partner mental health. Findings Five couples of people with BPD with frequent suicidal/self-injurious behavior or high suicidal ideation and their intimate partners received Sage. Measures of Sage targets as well as tertiary outcomes were administered at pre-, mid-, and post-intervention. Four out of five dyads completed Sage, with high intervention satisfaction ratings. Improvements were generally demonstrated in BPD severity, suicidal ideation, and suicidal behavior/self-injury. Half of dyads exhibited improvements in conflict, and additional improvements in mental health outcomes for dyad members were demonstrated. One dyad exhibited poor outcomes and speculations regarding this are offered. Conclusions Findings provide proof of concept of Sage as an intervention that can improve BPD and other mental health outcomes in those with BPD and their intimate partners. Incorporating intimate partners into BPD treatment may optimize and expedite its outcomes. However, further testing is needed. Trial registration This project was pre-registered at Clinicaltrials.gov (Identifier: [NCT04737252]).

This paper will explore the role of the therapist's values in couple therapy and the challenge these values pose to therapeutic neutrality. It will illuminate how the therapist's values shape what is considered healthy and unhealthy, functional and dysfunctional, and hence frame the problem the couple therapist seeks to treat. Values have particular relevance for couple treatment because the conversations the couple therapist facilitates may unwittingly privilege one partner's needs and wishes over the other's, creating the potential for therapeutic misalliances. This paper will explore common values and their impact on treatment, including the values of monogamy, gender equity, and talk intimacy (emotional expression as a path to intimacy). It will conclude by discussing how couple therapists can avoid partisanship with one partner and maintain a balanced approach in their couple work. [ABSTRACT FROM AUTHOR]

In this study, we investigated the association between clients' initial outcome expectations and their subsequent perceptions of the expanded therapeutic alliance. Romantic partners (N = 252) who received at least four sessions of systemic couple therapy from thirty‐one therapists from the Marriage and Family Therapy Practice Research Network (Johnson et al., 2017; www.mft‐prn.net) completed an outcome expectation measure before session 1 and a therapeutic alliance measure before session 4. Results showed a strong association between expectations and alliance (r = 0.51). While fourteen per cent of the variability in session 4 alliance scores was uniquely attributable to therapists, 31.6 per cent of the variability in the expectations/alliance association was uniquely attributable to couples, with only 6.1 per cent uniquely attributable to individual clients. Taken together, these results suggest that, while some therapists are better at developing strong alliances, couple and client factors associated with expectations for therapy set the stage for how the expanded alliance develops. [ABSTRACT FROM AUTHOR]

Couple Therapy for Depression (CTfD) is unique being the only NHS Talking Therapies Services (NHSTTS) therapy involving partners. As a couple therapy it is systemic as well as behavioural. CTfD is an effective intervention for both depression and relationship distress and achieves good recovery-rates for depression and anxiety compared with other 'high-intenstty' therapies. Delivery of CTfD in NHSTTS is inadequate. Over a third of NHSTTS provide no CTfD. When they do, delivery is so minimal that depressed clients cannot generally access CTfD. Since 2010, 1172 CTfD therapists have been trained yet, in 2021/2, only 1574 couples received CTfD (approximately one couple seen per year per therapist). This is wasteful given the investment of time and money. Constraints affecting delivery e.g. individually-focused organisational culture of NHSTTS, misunderstanding of the role of CTfD therapists, inappropriate referrals, inadequate supervision and delivery on a minimal scale, are discussed and recommendations outlined. Clients deserve genuine choice, staff need support to deliver CTfD effectively, and referral quantity and quality require urgent attention. [ABSTRACT FROM AUTHOR]

Background: Couple therapists will encounter couple violence in their practice at some point. In this context, one of the main questions they must address is whether to continue with conjoint sessions. This study explores how couple therapists make sense of their decision whether or not to continue with conjoint sessions when violence has become an issue. Methods: This qualitative study used four semi-structured focus groups and Interpretative Phenomenological Analysis (IPA) to analyse the data from the twelve experienced couple therapist participants. Results: Our IPA analysis led to three main group experiential themes across the focus groups: (1) Is it safe enough? (2) Do we have a joint and regenerative project? (3) Three key sources for sense making. Conclusion: Partner violence challenges the realm of couple therapy. This article explored how the couple therapists orient themselves and grapple with decision making when violence becomes an issue. The article offers unique insights regarding what the therapists orient themselves towards and how they try to form an impression of whether to continue conjoint sessions. We outline immediate clinical implications and propose measures for building individual and organisational capacity regarding "clinical sense making". Suggestions for further research are also addressed. [ABSTRACT FROM AUTHOR]

Third order thinking takes a metaview that links micro-level relationship processes with larger societal contexts. In Turkey, traditional and collectivist values originating generations ago and egalitarian and individualistic goals that emerged with the effects of modernization create tensions in family structures and intimate relationship dynamics. The familialist and conservative perspective that has dominated the political context in recent years and the discourse of equality, interpreted as sameness, exacerbate this tension. In this article, we discuss how to apply Socio-Emotional Relationship Therapy (SERT) in Turkey, a critical-social constructionist approach that enables practitioners to address how power imbalances and inequalities in larger societal contexts are manifested in the therapy room. Beginning with sociocultural attunement, SERT aims to transform social processes that prevent couples from developing mutually supportive relationships. It uses third order thinking to make power dynamics and sociocultural contexts visible, which enables partners to create alternatives to inequitable power processes by making sense of their experiences with a broader lens. Drawing on a heterosexual couple case example, we introduce the principles of SERT, the Circle of Care, and the clinical sequence and illustrate application in the Turkish sociocultural context. [ABSTRACT FROM AUTHOR]

Background: Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD. Objective: The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive–Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders – provider’s treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD. Results: There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments. Conclusions: This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships. [ABSTRACT FROM AUTHOR]

AbstractObjective Synchrony in the multi-person context of systemic therapy is a complex and understudied phenomenon. We analyzed respiratory and electrodermal synchronies within a couple therapy system with two therapists to determine whether dyadic subsystems between each client and therapist synchronized differently. We also studied synchrony in reflection periods, in which the therapists discussed the therapy process with clients listening. Finally, we examined the association of synchronies with alliance and outcome.Method: A sample of 22 therapy sessions in which electrodermal activity (EDA) and respiration were recorded were analyzed. Self-report measures of session alliance and outcome were obtained. Synchrony computation was based on windowed cross-correlation using surrogate synchrony and segment-wise shuffling of physiological time series.Results: The results supported the presence of EDA synchrony for the client-therapist and therapist-therapist dyads but not client-client dyads across entire sessions. No significant synchronies were found for respiration behavior. A similar picture was found in reflection periods. Clients’ well-being as well as therapists’ alliance ratings were significant predictors of client-client EDA synchrony.Conclusion: Our results point to the relational meaning of synchrony and its importance for understanding couple psychotherapy, particularly the reflection periods. Challenges involved in extending synchrony computation to multi-person settings were highlighted. [ABSTRACT FROM AUTHOR]

Introduction: Complaining is a frequent phenomenon in human interactions and it frequently happens during couple counseling. A conversation between a therapist and spouses that requires them to talk about problems inevitably leads to complaining (especially during the first meeting). The institutional context and the presence of an impartial therapist shape the complaining sequences. Method: We used conversation analysis to explore the interactional organization of complaining in the specific context, which is couples therapy. Our data involve video recordings of nine couple therapy first consultations. Results: In the results section of our paper, we describe in detail the composition and delivery of complaints in couple therapy setting. Our observations made it possible to propose a nuanced spectrum of ways of complaining that spans the considerateness dimension. Our data suggest that there may be a relationship between the manner of complaining and the presence and severity of maladaptive personality traits of complainers. Discussion: We argue that paying close attention to complaining practices that arise during couple therapy is an important aspect of clinical work with couples and can be informative regarding the nature of spouses’ quarrels and their personality constitutions. [ABSTRACT FROM AUTHOR]

The relationship between therapeutic alliance and treatment outcomes is one of the most widely studied topics in psychotherapy research. Research has primarily considered a unidirectional model whereby alliance predicts outcomes, which implies that building alliance early in therapy results in later symptom improvement and ignores the possibility that early symptom improvement could also subsequently lead to improved alliance. This study explored the bidirectional associations of alliance and outcomes session‐to‐session for 15 sessions among a sample of 24 couples randomized to emotionally focused therapy or treatment as usual for depression and relationship dissatisfaction. Multilevel models tested associations between the prior week's alliance and the following week's clinical outcomes (i.e., depressive symptoms and relationship satisfaction) and the prior week's clinical outcomes with the following week's alliance. Findings indicated that the prior week's alliance was associated with the following week's relationship satisfaction, but not depressive symptoms, when controlling for the prior week's depressive symptoms and relationship satisfaction in each respective model. In addition, the prior week's depressive symptoms and relationship satisfaction were both associated with the following week's alliance, when controlling for the prior week's alliance. Only one of these associations differed by sex: previous week's higher relationship satisfaction was associated with higher therapeutic alliance the following week for males than females. These bidirectional associations did not differ by treatment condition. This study contributes to the emerging empirical support suggesting bidirectionality among alliance and treatment outcomes. [ABSTRACT FROM AUTHOR]

Existing couple therapies are generally effective for reducing romantic relationship distress and divorce, but therapy outcomes remain poor for many. Outcomes can be improved through greater understanding of session‐by‐session therapeutic processes, particularly in real‐world treatment settings. Modern couple therapy models commonly emphasize the importance of emotional experiences as key change processes, yet few empirical studies have tested the merits of this focus. The present study addresses this limitation by examining trajectories of subjective emotions and their association with change in a key relationship outcome, relationship satisfaction, among military veterans and their partners at a VA Medical Center. Partners rated their relationship satisfaction prior to couple therapy sessions and subjective emotions immediately after sessions. Consistent with hypotheses, both hard (e.g., anger) and soft (e.g., sadness) negative emotions decreased significantly over the course of therapy. Those couples with greater decreases in hard negative, but not soft negative, emotions showed significantly more improvement in relationship satisfaction. Positive emotions did not significantly change across couples in general, but those couples whose positive emotions did increase also showed more improvement in relationship satisfaction. These results suggest change in subjective emotions may be one process underlying improvement in couple therapy and lend empirical support to the emphasis on emotion‐based change processes underlying acceptance‐based and emotion‐focused couple therapies. [ABSTRACT FROM AUTHOR]

Despite the pivotal role that emotion regulation is thought to occupy for individual and relational wellbeing, emotion regulation in couples has been surprisingly understudied. With a clinical sample consisting of 275 couples starting therapy from 2017 to 2022, this study sought to clarify the actor and partner effects of clinical couples' emotion dysregulation on relationship satisfaction. Our results showed that, for partners' emotion dysregulation dimensions, while impulse control difficulties, lack of emotional awareness, and limited emotion regulation strategies were negatively predictive of couple relationship satisfaction, nonacceptance of negative emotions had a positive association with relationship satisfaction. Further, compared with other dimensions of emotion dysregulation, female limited emotion regulation strategies were greater predictors of decreased female relationship satisfaction. We also found significant gender differences in partners' emotion dysregulation dimensions and relationship satisfaction. These results show the significance of addressing emotion dysregulation for both partners at intra‐ and inter‐personal levels simultaneously in couple therapy. Notably, the 275 couples in our sample did not report a clinically distressed relationship, though they attended at least one couple therapy session. Clinical implications and directions for future study are discussed. [ABSTRACT FROM AUTHOR]

Online programs that reduce relationship distress fill a critical need; however, their scalability is limited by their reliance on coach calls. To determine the effectiveness of the online OurRelationship program with varying levels of coach support, we conducted a comparative effectiveness trial with 740 low-income couples in the United States. Couples were randomly assigned to full-coach (ncouples = 226; program as originally designed), automated-coach (ncouples = 145; as a stand-alone program with tailored automated emails only), contingent-coach (ncouples = 145; as an adaptive program where tailored automated emails are followed by more coaching if couples did not meet progress milestones), or a waitlist control condition (ncouples = 224). All analyses were conducted within a Bayesian framework. Completion rates were comparable across conditions (full-coach: 65 %, automated-coach: 59 %, contingent-coach: 54 %). All intervention couples reported reliable pre-post gains in relationship satisfaction compared to waitlist control couples (dfull = 0.46, dcontingent = 0.47, and dautomated = 0.40) with no reliable differences across intervention conditions. Over four-month follow-up, couples in full- and contingent-coach conditions maintained gains in relationship satisfaction and couples in the automated-coach condition continued to improve. Given the comparable completion rates and minimal differences in effect sizes across intervention conditions, all three coaching models appear viable; therefore, the choice of model can vary depending on available resources as well as couple or stakeholder preferences. This study was preregistered (ClinicalTrials.gov NCT03568565).

Intimate Partner Violence (IPV) or Domestic Violence (DV) affects the mental health of women. Systemic family therapy has been found to help bring change in a couple's relationship and the cessation of violence in the relationship, provided both couples are motivated by the therapy to preserve the marital relationship. This article presents a case of offering brief tailor-made individual intervention as well as couple therapy for a woman with depression experiencing violence. [ABSTRACT FROM AUTHOR]

• Overview of development of Sage for borderline personality disorder (BPD) • Sage is a conjoint therapy for people with BPD and significant others (SOs) • Sage targets BPD, relationship functioning, and SO mental health. • Sage has three phases: safety, communication/emotion regulation, and beliefs. • Sage may optimize, expedite, and expand access to intervention for BPD and SOs. Borderline personality disorder (BPD) is associated with several destructive behaviors, including suicide and nonsuicidal self-injury. The devastating effects of BPD impact individuals with BPD, their relationships, and the mental health of significant others (SOs), which research suggests may be suboptimal. Few BPD interventions incorporate SOs into treatment, despite research suggesting that both emotion dysregulation and relationship dysfunction contribute to the maintenance of BPD. Incorporating SOs into treatment presents an opportunity to optimize BPD outcomes, while dismantling emotional and relational factors that maintain BPD and improving SO mental health. This paper describes the development of Sage, a 12-session conjoint psychotherapy intervention delivered to individuals with BPD who engage in suicidal and nonsuicidal self-injurious behavior, or have suicidal ideation, and their SOs. It is designed to simultaneously target BPD pathology, relationship functioning, and SO mental health. Sage is a time-limited cognitive-behavioral intervention that is primarily informed by cognitive-behavioral conjoint therapy for posttraumatic stress disorder (Monson & Fredman, 2012) and dialectical behavior therapy (Linehan, 1993, 2015). This paper describes the development of the intervention, including key skills taught, logistical issues that were encountered in its delivery, and relevant solutions. Future directions in the development and testing of Sage are described. [ABSTRACT FROM AUTHOR]

This article provides a perspective on implementing the Satir Model-Focused Couple and Family Therapy Program in Türkiye and how the first author of this article Sibel Erenel (SE), Licensed Marriage and Family Therapist, AAMFT approved supervisor, has tailored the program and the Institute. The program's main features and uniqueness are explained, as well as the program's focus on competency-based training using one major model. Furthermore, how the program aligns with international competencies is discussed. The article highlights the program's 18 years of growth in the region and the Institute's expertise, which adds credibility to the future implications and recommendations for new program developers. Overall, this article offers a comprehensive understanding of establishing Satir Human Development and Family Therapy Institute and how (SE) launched a competency-based, Satir Model-Focused Couple and Family Therapy Certificate Training Program in Türkiye, where couple and family therapy was in its infancy. Therefore, this article is a valuable resource for anyone interested in the practical application of Satir Transformational Systemic Therapy Training and CFT. [ABSTRACT FROM AUTHOR]

Relationship standards are beliefs about what is important in high‐quality couple relationships. Clarifying standards cross‐culturally informs theory about relationship quality and goals for culturally appropriate couple therapy. The current study assessed four standards (Couple Bond, Family Responsibility, Relationship Effort, and Religion) in n = 113 Malay Muslim couples, and the association of those standards with marital satisfaction. All four standards were strongly endorsed, Religion was the most strongly endorsed, and there were minimal sex differences. Separate actor–partner interdependence models showed actor effects of all four standards on own satisfaction for husbands and wives, partner effects of three of the four husbands' standards (not Relationship Effort) on wives' satisfaction, but no partner effects of female standards on male satisfaction. The findings underscore the importance of all four standards in Malay Muslim marriages and that attention to all these standards might need to be part of couple therapy with Malay couples. [ABSTRACT FROM AUTHOR]

This study uses James Donovan's object relations couple therapy to examine the triangle of focus (conflict style, couple characteristics, and family of origin) and triangle of conflict (anxiety, defence mechanisms, and hidden emotions) of a married Korean man with sexual dysfunction (reduced sexual desire, premature ejaculation, and erectile dysfunction). This qualitative study uses thematic analysis to identify, describe, and analyse a family therapy case study. The aim of this study is to examine the couple's interaction patterns and experiences of conflicts related to the husband's erectile dysfunction. The researchers induced patterns or topics by repeatedly reading and comparing the data. Then, they textualised and analysed the relevant data. To ensure the reliability and validity of the data analysis, the researchers conducted shared coding sessions to review and discuss the initial codes and the generated main themes and subthemes, triangulating the qualitative data. Findings show that a newlywed husband's sexual dysfunction is associated with his emotional resistance towards his wife's unilateral pursuit over their sexual relationship and the negative emotions triggered by their dysfunctional interactions. Further, couple characteristics, conflict style (dysfunctional interactions), and family‐of‐origin factors (transference and patrilocality) influenced their sexual relationship. Therefore, therapists who counsel Korean couples with sexual issues may pay attention to the sociocultural factors, interactional patterns, and psychological factors associated with unresolved issues with their families of origin. [ABSTRACT FROM AUTHOR]

Research on the gendered division of household work in western political economies often neglects its emotional dimensions. This conceptual paper draws on concepts of emotion work and feminist care ethics to explore gendered and intersecting divisions of emotions and emotional work in couple relationships and their implications for couple therapy. Although emotion work has been studied in workplace settings, less attention has been paid to inequalities in the privatized realm of interpersonal relationships, including romantic and filial ones. Women and feminine partners' culturally presumed expertise in emotions typically positions them as carrying primary responsibility for managing emotions in intimate relationships. Couple therapy is an important site of interaction that can both support and, potentially, disrupt the invisibility and gendering of emotion work in intimate relationships, thus shedding light on recurring patterns of women's subordination and exploitation. We conclude by advancing suggestions for addressing gendered and intersectional dimensions of emotion work in therapy practice. [ABSTRACT FROM AUTHOR]

Couple therapy has outperformed control conditions in randomized clinical trials (RCTs). However, there have been some questions whether couple treatment in naturalistic settings is as effective as those with more rigorous controls. The current meta‐analysis examined 48 studies of couple therapy in non‐randomized clinical trials. The pre–post effect size was Hedge's g = 0.522 for relational outcomes and Hedge's g = 0.587 for individual outcomes. However, there was significant heterogeneity in the results. Several moderators explained some of the variance in these estimates. For relationship outcomes, studies who had older couples and longer length of relationship had better outcomes. Studies with a higher percentage of racial/ethnic minority (REM) couples and studies in Veteran Affairs Medical Centers (VAMC) had lower relational outcomes. For individual outcomes, studies that had more sessions, older couples, and VAMC had better outcomes. Studies with a higher percentage of REM couples also had worse individual outcomes. Trainee status was not consistently related to relational or individual outcomes. Implications for research and practice are provided. [ABSTRACT FROM AUTHOR]

People affected by infidelity show symptoms similar to post-traumatic stress disorder. This study sought to compare the efficacy of emotion-oriented couple therapy (EFCT) and cognitive-behavioral couple therapy (CBCT) in treating post-traumatic stress disorder (PTSD) in women affected by infidelity. This study was quasi-experimental, with a pre- and post-test design, and a control group. The statistical population included (n = 69) infidelity-affected women referred to the apple clinic in Mashhad during the first quarter of 2020. Using the available procedure, 45 infidelity-injured subjects were selected and distributed into three groups: CBCT, EFCT, and control (15 cases in each group). The Impact of Event Scale (IES) was administered to all three groups before, after, and two months after intervention. The obtained data were analyzed using SPSS-20 statistical software and statistical techniques for analysis of variance of duplicate data. In comparison to the control group, the CBCT and EFCT demonstrated a significant reduction in PTSD scores. Cognitive couple therapy was more effective than emotion-focused couple therapy (P

Introduction: Extramarital affairs disrupt family functioning and have serious negative consequences for the family members. Aim: The present study aimed to compare the effectiveness of combined cognitive-behavioral couple therapy and integrated behavioral couple therapy in improving family functioning in couples with extramarital affairs. Method: In this quasi-experimental study, with a pretest-posttest control group design, the statistical population consisted of all couples, referred to the counseling centers of Mashhad, Iran in 2021. Thirty nine couples were selected using the convenience sampling method among people with extramarital relationships and randomly assigned to three groups: control group (13 couples), combined cognitive-behavioral couple therapy (13 couples), and integrative behavioral couple therapy (13 couples). The experimental and control groups completed the Family Functioning Scale by Epstein et al. (1983) before and after the interventions. In order to data analysis covariance analysis was performed in SPSS version 20. Results: Results indicated that the scores of all family functioning components significantly decreased in the intervention groups compared to the control group (P